Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 13825 | TX |
NPI | 1003308107 |
---|---|
Provider Name | Dr. Megan Faith-Lee Shortell |
First Address | Austin, TX 78749-2924 |
Second Address | Cedar Park, TX 78613-3853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2018 |
Last Update Date | 04/06/2018 |